Painful sex? Check out our helpful tips about what you can do to help!

If you’re having pain during sex, try the following tips:

You should have a consult with a pelvic floor physical therapist for training on positioning and how to use a set of vaginal dilators:

They are used to stretch the vaginal tissue, facilitate pelvic muscle relaxation and prepare for intercourse.

If you are able to have penetrative sex:

  • Practice breathing techniques or stretching prior to intercourse
  • You may want to begin with clitoral stimulation to increase natural lubrication and vaginal expansion prior to insertion
  • You can use the dilator with your partner if you feel comfortable as a way to transition from medical to sexual use of dilator. This practice can help prepare you for engaging in sexual intercourse and help you both come to understand the challenge of the healing process and develop skills for working together as a team
  • The transition from plastic dilators to a partner’s penis is often an exciting step for a couple. To make the transition, your partner has to learn a passive role, letting you control the insertion and then just resting inside the vagina for a while. In time you can expand this exercise to permit insertion by the male of his own penis, clitoral stimulation, some thrusting and experimentation with different positions.
  • Use plenty of lubricant and use one that is water soluble
  • Apply ice or frozen blue gel pack wrapped in one layer of a hand towel to relieve burning after intercourse. Frozen peas or corn in a small sealed plastic bag mold comfortably to vulvar anatomy.

Keep in mind that intercourse isn’t always 100% comfortable. Temporary tugs and pressures are often just part of getting started. If some minor discomfort exists, try moving ahead anyway – but if obvious pain persists, don’t ignore it, stop. If you encounter unexpected difficulty, you may want to practice with the dilators some more before attempting intercourse again. Continued dilator use may be necessary from time to time, to keep the vaginal area relaxed and comfortable.

Help, I’m having pain in my left ovary!

 

 

 

 

 

 

OBGYN’s hear this complaint frequently and of course, will examine your reproductive organs.  However, most one sided lower abdominal pain is not due to problems of the either ovary, but mainly due to  muscle tension that crosses the same region where the ovaries are located.

 

It could be a hip or back muscle.

This image shows your hip flexor, called the iliopsoas muscle.    The x’s show where trigger points of this muscle are typically located. The red dots show the areas where people complain of pain

 

 

 

This image shows a back muscle called the quadratus lumborum or QL for short.

 

 

 

Both of these muscles can refer pain into the lower abdomen as shown in the shaded red dotted areas. This can commonly be interpreted as ovarian pain.

How to self-treat:

Hip flexor stretch:

Begin in a half kneeling position with your front left knee bent at a 90 degree angle. Next, squeeze the glutes and tuck in your tailbone, while gently lunging forward to feel a stretch in your right hip flexor. Switch sides. Do 2x 30 second holds, twice a day.

Quadratus Lumborum stretch:

Straddle a chair. Side bend to the left side and imagine you are trying to lift your right ribcage up and drop your right hip downwards, to feels a stretch on right side of the body. Switch sides. Complete 2 x 30 second holds, twice a day.

If pain persists or gets worse, see a women’s health physical therapist.

April the Giraffe had her baby standing up! What position will you give birth in?

Like many of you, I spent an April 15 Saturday morning watching April the Giraffe give birth to a healthy boy calf. I think he was something like 6 feet tall and 150lbs. While watching the live stream I couldn’t help noticing all the people comment: “Why is there no one with her?” “Where’s the Veterinarian?”   Of course others jumped in saying “She’s a wild animal and there are no doctor’s in the wild!”

It struck me how natural birth is, but how controlled humans have made the process, especially in hospitals.

In February 2017, the ACOG (American College of Obstetricians and Gynecologists) released a paper entitled “Approaches to Limit Intervention During Labor and Birth”. In this document, OBGYN’s are reminded that “Labor management may be individualized” and include “such techniques as non-pharmacological pain relief”

The paper also advocated for delayed admission when both the mom-to-be and baby are stable in status. Once admitted, OBGYN’s are reminded to employ: “education and support, oral hydration, positons of comfort…massage, or water immersion”. This new view point is very empowering!

COMFORTABLE BIRTHING POSITIONS

 

So let’s talk “positions of comfort”. Upright position on hands and knees or deep squat can be beneficial because gravity can assist with pushing, uterine contractions will be stronger, and there is less compression on the mother’s aorta (increasing blood supply to the baby). X –ray evidence even shows that the pelvic outlet is larger in upright position meaning more space to get the baby out. (Gupta et al. 2012).

There’s also lots of buzz about water births nowadays so what’s the deal? ACOG has conceded that water immersion during the first stage of labor can shorten labor and reduce need of pain medication. They do however recommend that birth “occur on land” vs. water, but women are allowed to give birth in water if they are informed of the risks. The American College of Nurse Midwives notes that there is a “large and growing body of research that supports water birth as a reasonable choice for healthy women experiencing normal labor as well as birth.”

Almost 75% of women get epidurals and may be limited in their ability to stand after the injection. They are still not limited to the traditional birthing position on their back. Several women have recently reported giving birth on their side post epidural and felt more control despite not feeling much control in other positions.

The bottom line of all research seems to be that women should feel empowered to labor and push in whatever position feels right to them at the time. So moms-to-be advocate for yourself and do what feels right!

For more information:

Gupta et al. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012;2:CD008070.

http://www.acog.org/Patients  Patient resource page from the American college of obstetricians and gynecologists

http://www.acnm.org/ official website of the American college of nurse midwives

Hey Women! Let’s learn about your lady parts!

With women’s rights being a hot button issue recently, it got me thinking: how many women really know and explore the parts that make them a woman? (Disclaimer: I’m not forgetting those in the LGBQT community who have different anatomy and identify as a woman. You do you, girl!)

So ladies…What’s down there? Grab a mirror and play along.

 

 

 

 

 

 

 

 

Externally you will see three openings:

  1. The urethral opening which is closest to the front of your body (where we eliminate pee)
  2. The vaginal opening in the middle (where intercourse occurs and also the birth canal)
  3. The rectal opening below (where we eliminate poop)

The urethral and vaginal openings are housed in the first skin layer,        called labia majora (with pubic hair) and just underneath, the labia minora (hairless layer) that protect these openings.

Also protected by the labia just above the urethral opening is a small sensitive, nerve filled structure with two hidden “legs”  that surrounds either side of the vaginal opening called the Clitoris. The head of the clitoris is very sensitive and serves in sexual function for arousal when stimulated.

 

 

 

 

 

 

 

The clitoris is considered the most erogenous zone on the female body.  Stimulation of the more than 8,000 nerve endings here can lead to the rhythmic, quick flick pelvic floor contractions that we interpret as pleasurable. Yes, I’m talking about orgasm!

Now that you are acquainted with the anatomy use a mirror to check your own lady parts. Then do some of the following movements:

  1. Try a Kegel: contract pelvic floor like you are stopping the flow of urine or don’t want to pass gas. You’ll  lifting of the pelvic area upwards
  2. Try a reverse kegel: bear down like trying to pass a bowel movement. You should see the pelvic area gently bulge outward
  3. Cough or laugh. You should observe an initial lifting up/in of the pelvic floor, with a quick relax back to normal position

 

Let’s take a look at the Pelvic Floor muscles.

In this image, the external skin is removed and you are now looking at the underlying muscles. These muscles are important stabilizers of the pelvis and serve many functions: bowel and bladder control, core stabilizers, involved with sexual function and support of bladder and other visceral organs.

You can check your pelvic muscles by inserting one clean finger into the vaginal opening to the level between 1st and 2nd knuckle. Assess your strength by squeezing the inserted finger (doing a kegel) by contracting your pelvic floor muscles.  You should feel a ring of tension around your finger and feel a gentle pull upwards toward your head.

Assess for tension in the muscles by stretching directly to the right, left, down and diagonally up/right, diagonally up/left, down/right, down/left. No need for direct upward pressure as this is where your urethra is located.  A healthy pelvic floor should feel no pain, only pressure or stretch.

I hope this helped you to feel more comfortable and aware of your female anatomy. In a study published in the International Journal of Sexual Health, scientists found that women who had a positive view of their genitals were more comfortable in their skin, more apt to orgasm, and more likely to experiment in bed. So go ahead and get to know your lady parts.

Remember:

A healthy female pelvic floor has

  • no pelvic pain or pain/tingling/feeling of pressure in the sexual organs,
  • painless intercourse and insertion of tampons,
  • the ability to stay relaxed and soft, not to be chronically tense, which leads to pelvic/back/hip pain,
  • ease of voiding (of pee and poop) with no issues of frequency, bladder pain, nor straining during every BM due to constipation
  • no leaking when lifting weights, laughing , sprinting for a bu

If you experience any symptoms, consult an experienced pelvic floor physical therapist for evaluation and guidance.

Chronic Pain and sexuality: How Eva Margot Kant, LCSW-R helps people navigate these issues

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(Image courtesy of Eva Margo Kant, LCSW-R)

The National Institute of Health (NIH) defines chronic pain as pain lasting more than 3 months and it affects more than 100 million Americans today.  As a pelvic floor physical therapist, I help patients with both acute and chronic pain, more specifically pelvic pain, on a daily basis. Due to the private nature of pelvic floor issues, sexual dysfunction, or bowel and bladder complaints it can be difficult for patients to feel comfortable talking about their symptoms.

The famous quote, “no man is an island,” rings true for healthcare providers who treat chronic pain as multiple specialists working together is more effective than one. I recently met with Eva Margot Kant, LCSW-R  with 12+ years of experience helping people deepen their self-esteem, navigate life’s transitions, and address fears and questions about chronic illness/pain which includes topics of sexuality and sensuality. Eva taught me some great perspectives on how she helps people heal their emotional/sexual wounds and how they can be a source of chronic pain.

Eva runs workshops about sex and disability, sex and aging and trains medical students how to talk about sex with their patients. Her goal is to help people “unpack their feelings” that are attached to physical pain and anxiety. Anxiety increases the output of the limbic system, the emotional flight or fight, and memory areas of our brain which results in pain.

Eva believes that “understanding how the body works is the key to understanding you”.  Her job is to help people understand what their sexuality is to them and to own how they view and understand it.  Eva believes that “the body always remembers.” She likened the reflexive blink of an eye that’s about to be poked to the feeling a woman with sexual pain feels if her partner demonstrates affection. The woman may fear that any show of affection may lead to sex which is painful for her, so she avoids this.

Eva’s goal is to help patients learn if some physical reflexive tightening may be due to thoughts involving shame, guilt, or embarrassment.  She helps clients decide when to disclose to a new partner about their chronic condition. She stressed the importance of self-care with their partner and to feel emotionally safe. People who have chronic pain/illness may go thru life as if they are “holding their breath.” Often times Eva finds that partners want to help, they just don’t know how. Demystifying chronic pain/illness allows partners to be supportive and an active participant in healing.

Eva’s upcoming book and course work, called “The Holy Trilogy of Sex (c),” guides patients and their partners in sensuality, sexuality, and intimacy; none of which are possible without communication, sensation, and connection. She encourages partners to engage in body mapping: offering each other a “menu” of intimate ideas that can promote togetherness without causing more pain.

As a Pelvic Physical Therapist, I invite my patient’s partner to a session to observe, learn, and understand what my patient is experiencing and teach the partner ways they can help. I work on the physical aspect of pain with my manual, movement and exercise therapies while Eva addresses on the mental and emotional aspects of chronic pain which leads to a more efficient outcome.

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EMH Team; Jennifer Jurewicz, Tova Laufer & Charissa Morrisroe with Eva Margot Kant, LCSW-R

If you have chronic pelvic pain consider receiving both physical and talk therapy to get your life back on track.  Consider visiting us at EMH Physical Therapy and Eva Margot Kant, LCSW-R if you are in the NYC area. Your pelvic floor with thank you!

Resources:
http://evamkantlcsw.com/
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

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What is Somatic Experiencing® and How Does it Heal Trauma/Chronic Pain?

Dr. Sharlene Bird Visits EMH Physical Therapy

One of the things I love most about being in the healthcare field is learning from other practitioners. Through my years as a physical therapist treating chronic pain patients, I’ve found that a team approach works better than an isolated one. So, when Dr. Sharlene Bird, a clinical psychologist, came to talk to the EMH team I couldn’t wait to pick her brain!

Dr. Bird is a New York State Licensed Psychologist, Certified Sex Therapist and Certified EMDR (Eye Movement Desensitization and Reprocessing) Therapist who specializes in CBT and SE®. Say What? Let me translate the alphabet soup.

Dr. Bird has been in practice for over 20 years treating individuals and couples who experience sexual dysfunction and/or childhood trauma.

Initially, Dr. Bird mainly used a cognitive behavioral therapy (CBT) approach, aka “everything is in the head”.  However, over the past seven years, she’s been integrating Somatic Experiencing® (SE) with great results.

Somatic Experiencing® (SE)

SE®, developed by Dr. Peter Levine, focuses on the patient’s actual physical response in conjunction with the nervous system’s reaction to past traumatic experiences. There is a healthy range of responses to trauma which doesn’t wreack havoc on our physical and emotional stability.

In the graph below, you’ll see a normal range of responses: settling between being activated/heightened or relaxed/lowered.

Somatic-Experiencing-Healthy-Nervous-System

image credit www.mindfulsomatictherapy.com/

Unhealthy levels are those responses that are outside of the “normal” range. If a patient is too elevated above the normal range they may be suffering with anxiety, panic, digestive issues, hypersensitivity to sounds (heightened startle reflex), sleep problems or chronic pain.

Too low under normal range and a patient may be suffering with depression, flat affect, lethargy, poor digestion or chronic fatigue.

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image credit www.mindfulsomatictherapy.com/

SE® helps the body resolve physical and emotional trauma so one can reach a sense of being “settled.” By working with her patients on becoming present and mindful in a safe space, Sharlene helps her patients heal.

As a DPT I’m obviously focused more on the “body healing” side of things, but I understand that our mind plays a big role in how we process pain.

Releasing Trauma

With the SE® approach, Dr. Bird asks a patient, “As you recall that trauma, what begins to happen inside your body?” this allows the patient to focus on the senses their body is feeling. The simple act of being mindful of how the body feels when remembering a traumatic experience plays a large role in freeing trauma. The patient will then be able to resolve the stalled ‘fight-or-flight’ response that occurred at the time of their trauma. This treatment approach completes the loop to healing.

Dr. Bird works with patients for weeks or months to learn to read and help patients sense what is going on in their bodies in small manageable bits. She creates an environment that is moderately stressful, but still safe and controlled, to expand the capacity for creating new experiences and learning to “ride the wave.” The end goal is to re-establish a natural ability of the nervous system to shift smoothly between being activated and settled within the normal ranges.

Dr. Bird encourages mindfulness and sensory awareness and ended her presentation with a quote by Steve Goodier that is so fitting and helps us appreciate our bodies:

“You have a great body. It is an intricate piece of technology and a sophisticated super-computer. It runs on peanuts and even regenerates itself. Your relationship with your body is one of the most important relationships you’ll ever have. And since repairs are expensive and spare parts are hard to come by, it pays to make that relationship good.”

In today’s hectic world we can all use a reminder to be kind to ourselves and our bodies and keep that relationship “good.”

You are here

If you feel like Somatic Experiencing® will help you on your healing journey, see the resources below for more information. Happy feeling & happy healing!

resources:

http://www.drsbird.net/: for more about Dr. Sharlene Bird

http://somaticexperiencing.com/: for more on Dr. Peter Levine and Somatic Experiencing®

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How to Foam Roll Most Major Muscle Groups in 5-10 Minutes

Don’t you wish you could get a deep tissue massage every day? If you said “yes!” then I highly recommend you make a small investment in your own foam roller.

I foam roll every time I go to the gym because it’s the easiest way to self-release all of the major muscle groups. Foam rollers act on the fascia, or connective tissue, that lies above all muscles and organs of your body. When you use a foam roller, you’re making the fascia mobile, which ensures all structures underneath will function without restrictions.

When ordering remember: darker colors usually mean a firmer roller. If you are a beginner try white or a light color. If you want a deeper, firmer tissue massage go with dark grey or black.

Check out my quick video that hits most major muscle groups in just a few minutes. Happy rolling!

Having trouble losing the “Mom Belly” Post Baby?

Why diastasis recti may be your problem and how you may be making it worse…

checkyoself

 

If you’re doing a million crunches to get your abs back post baby but can’t seem to lose that last little “pooch,” STOP!! You may be experiencing a very common postpartum complaint: diastasis recti.

 

What is diastasis recti?
It’s a separation of your rectus abdominis (6-pack muscles). As your belly expands during pregnancy, the connective tissue between the right and left sides of the muscle (called the linea alba) stretches to accommodate your growing baby. This separation may persist postpartum and in some women does not naturally reduce. This gap leaves your abdominals less functional, weaker and allows the other soft tissues to hang out. This causes that little belly that most new moms learn to hate.

Do I have diastasis recti?
Lay on your back with your knees bent and feet flat on the floor. Place 2 fingers at your belly button. Now lift your head like you’re trying to look at your belly while keeping your abs relaxed. Do you feel a gap along the midline of your abs at your belly botton, how about above or below the belly button? If you can fit more than 2 fingers in this “gap” you have a moderate-severe case of diastasis recti.test

What can I do about it?
Don’t freak out! You can learn a simple exercise to “brace” your abdominals that will begin to close this gap. Begin on your back with knees bent, feet flat and try to engage your deep abdominals by inhaling and bringing the navel to the spine as you exhale. See the exercise program below (“Other Resources” at the bottom of this blog) for a beginner plan geared towards closing the gap of your diastasis recti. If your goal is to get back to running, yoga, barre classes, spin classes etc., it’s recommended that you attend a few (anywhere from 2-12) PT sessions in order to strengthen your abdominals and avoid stressors that you’re not ready for. For example, planks and crunches are too challenging for abdominals weakened by diastasis recti and can worsen the separation if done improperly or too soon.

Bracing Steps (standing & lying down)

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Other Resources:

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Home exercise program for beginners: View at www.my-exercise-code.com using code: TGQQAGV

http://mumafit.com.au/  A site created by an aussie mom of 3, Maternal Wellbeing Specialist, and International Holistic Life and Wellness Coach. She also has a very popular app that has quick and easy exercise programs for during and after pregnancy.

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P-A-I-N is a 4 letter word, but so is T-E-A-M

IMG_4839Why a team approach of seeing MD and Physical Therapy under one roof is ideal for treating chronic pain.

If you have chronic pelvic, urologic,  sexual pain/dysfunction and can answer “Yes” to this statement:

“I’ve been to a number of medical practitioners about my pelvic condition and still don’t have a definitive treatment plan”, you’re not alone!

Just like the saying  “No man is an island”, no single practitioner can provide the breadth of treatment to help patients heal from chronic pelvic pain/dysfunction without working together in a TEAM of health care providers.

” Pelvic Help for Pelvic Pain”  is a 2 week intensive, non surgical program in NYC designed and provided by EMH Physical Therapy and Dr. Robert Echenberg MD.

The program is based on a Bio-psycho-social model of care which is evidence-based on neuroscience and pain processing disorders that are triggered by both functional and structural pain generators.

During the 2 weeks, you’ll receive a thorough education about pain and how pain can be retrained, receive a variety of treatments that includes medicines, trigger point injections, manual therapies, biofeedback and instruction in a tailored home exercise/management program.

It makes sense to address pain from all angles at the same time and this team approach with such open communication between MD, PT’s and other disciplines such as acupuncture and talk therapy is unprecedented and unmatched today. If you think you’ve tried everything else, try one more thing because it works!

Patients who attended our 2 week “Pelvic Help for Pelvic Pain”  program report a sense of well being, get pain relief, learn many self help tools and feel empowered that they can continue to heal.

The following is an interview of an international 32 year old female patient with 20 years of pelvic pain who traveled to NYC to attend our program:

Q: What was the best part of the intensive 2 week “Pelvic Help for Pelvic Pain” program?

A: The best part was the global approach to my health condition by MD and DPT. Working together,  which is rare in my country, gave me a broader view of my pain and of my power to overcome it.

The compassionate way Dr. Echenberg and the EMH PTs treated me was very supportive. As chronic pain is very stressful, the caring treatments and the kindness of these health professionals were very important and one of the best parts.

Q: How did you feel at the end of the 2 weeks?

A: I felt very well educated about my pain and about my role in my treatment. I was trained by PT to be able to continue my exercise program in South America and I felt I wasn´t alone with my pain, because they told me that they´ll continue support me even with the distance. The symptoms didn´t disappear, of course, because it´s a chronic pain but I felt better and well prepared to deal with it.

We have openings in our program!

Call (212) 288-2242 to schedule your appointment.

For more information about Dr. Echenberg go to his website, http://www.instituteforwomeninpain.com/For more information about EMH physical therapy, go to their website, http://www.emhphysicaltherapy.com.

Endometriosis: ladies, let’s talk about it!

I fight like a girl graphicIt’s rare these days that a high profile celeb talks about anything that isn’t skin deep or filtered on Instagram. That’s why I give props to Lena Dunham (of HBO Girl’s fame) for writing an open and honest letter to her fans citing her endometriosis as the reason she will be missing from the press tour for the new season of her hit HBO show. That got me thinking, what other celebs have endometriosis? Are they just like us? Whoopi Goldberg, Hillary Clinton, Dolly Parton, Emma Bunton of the spice girls, Julianne Hough, and possibly Marilyn Monroe have all been linked to the diagnosis. That’s not surprising as 1 in 10 women have endometriosis, with more than 170 million women worldwide having already been diagnosed often after several years of debilitating pain.

1 in 10 women have endometriosis

So what exactly is endometriosis? Simply put, the tissue that lines the uterus (called endometrial tissue) somehow spreads to areas that it shouldn’t be causing pain and possible infertility. Endometrial tissue has been found in the adjacent areas of the body: vagina, cervix, rectum, abdomen, ovaries, bladder, and even the lungs or brain. Symptoms can include pelvic pain, painful intercourse, severe abdominal cramping, heavy periods that leave the woman incapable of leaving her bed, constipation or diarrhea, infertility or difficulty conceiving, and chronic low back pain.

What causes this terrible, invisible disease? Nobody really knows. Theories include: genetics, stress, hormone imbalance, toxins or environmental factors, a defect during embryonic development, or immune system defect. Think the symptoms sound familiar? How do we diagnose a case of endometriosis? The only way to confirm diagnosis is to “take a look” with a laparoscopic surgery which in itself introduces new injury and potential scar tissue to an already vulnerable area. At least the theory that a hysterectomy would “cure” endometriosis has been thrown out in recent years as that pesky endometrial tissue has estrogen of its own, and can re-grow in absence of a uterus. So basically our bodies can attack us from the inside at any moment without anything to be done about it?!

But wait, there’s hope! Although more research needs to be done about potential treatments and cures, there are a lot of options out there. The gold standard of diagnosis and treatment is a laparoscopy, but the tissue may grow back. Birth control or hormone therapy may help with menstrual pain and avoid a monthly relapse.

Pelvic floor PT can also help in reducing abdominal restrictions and decrease abdominal pain and cramping in addition to strengthening the core and pelvic floor muscles. Decreasing the restrictions caused by the endometrial tissue can free up the nerve endings in the abdomen decreasing pain signals sent by the entrapped nerves. Chronic pain additionally causes increased muscle tension due to our body’s protective contraction of muscles in the area that hurts. Manual techniques by a physical therapist can also help reduce this muscle tension, leading to father relief of chronic pain and faulty postures. Other forms of exercise can also be helpful including biking and walking.

Many women anecdotally report their endometriosis was “cured” after giving birth, but this is not always the case. Some have had success with acupuncture, massage, or working with a dietician to hit the disease from every angle.

The moral of the story is: DON’T GIVE UP! You’re not alone, there is help out there. The more people talk about endometriosis the less “imaginary” and “invisible” it will be. Here are some additional resources to check out for more information about endometriosis and treatment options:

The Endometriosis Foundation of America:    http://www.endofound.org/endometriosis

U.S. endo March (kind of like the Susan G Komen breast cancer walk) Happening March 19, 2016 in San Francisco!  http://www.endomarch.org/

The endometriosis association: http://www.endometriosisassn.org/endo.html